Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial

Re: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial

Limitations listed for this trial did not include close involvement of the funder in its design and execution. Under ‘Finances’, the authors state: “The Department of Health reviewed the protocol … and provided project manager support”.[1]

The Department of Health makes greater claims for its own involvement in the trial. In January 2012 it signed a ‘concordat’ with the technology industry, which referred to “a randomised controlled trial funded and run by the Department of Health” (paragraph 1).2

The authors have not commented formally on the substantial mismatch between their findings and conclusions (which were measured and cautious[1]) and those used by the Department of Health to inform policy (which were one-sided and sensationalist[2,3]), though individual WSD researchers have expressed misgivings.[4]

Randomised trials, which ‘control for’ context, have limited purchase for evaluating politically driven e-Health programmes.[5] The Department of Health’s cherry-picking of unanalysed data to put on its website before the trial had finished recruiting was scientifically inappropriate but politically expedient.[6]

The BMJ has led the field in exposing how the pharmaceutical industry’s conflicts of interest distort research. In failing to require the WSD’s authors to consider conflicts of interest by the state (whose intention to implement telehealth was enshrined in policy before the WSD results were analysed[7]), and in privileging randomised trials over study designs that allow analysis of political influences,[8] the BMJ has let itself to be used as a pawn by an increasingly powerful industrial-political complex.